MacGyver Guide: Getting Crafty With A Bridge And Final Screw Retained Emax On A Legacy3 Implant

MacGyver Guide: Getting crafty with a bridge and final Screw Retained Emax on a Legacy3 Implant

Case Study by: August de Oliveira, DDS

Here is a cool little case. Bridge with decay through the furcation. Patient only wanted one

implant on #30. I know that I will need an apically positioned flap, so I want to know not only

where the nerve is, but where the Mental Foramen is as I am going to do a release.


No guide, as the patient comes from 3 hours away and was unsure at the consult if she wanted

to go through implants, so I got all MacGyver on it. Drilled a hole through the pointing central pit

with some diamonds and some metal cutting burs, actually not as hard as I thought. I know I am

in D2 bone per the scan, so I used a lance bur then the pilot through the hole. Not total control

but at least angulation and position.

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I still use stops, why not? Also knew from the get go we were talking about D2 bone so out went

the crestal bone drills.

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Socket graft with DFBA and resorbable collagen membrane. Should I have done non-resorbable?

Well, she is not getting an implant and she has a ton of bone above the nerve so I was not too

worried about it. I just grafted it as I wanted to make sure I did not lose bone distal to my

implant. Placed the implant. Apically positioned flap. Will restore in 3 months.

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Patient came back in 3 months ready to restore. Here is the sequence for taking images in CEREC 4.2 for a custom abutment or screw retained crown:

1. First Remove healing abutment. Go to "Add Catalogue" in the Acquisition screen and "Add GingiMask". Take your gingival mask images.

2. Do not put on the scan post. Take your buccal bite images. 3. Now place your scan post and scan cap. Make sure the notch on the buccal really lines up.

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Designed and milled in CEREC 4.2. Used an A2 size 16 block for a screw retained. If I was to use

an abutment I would have used a 14 MO block and a separate Emax regular block for the crown.

Always switch out your abutment screw for the manufacturer provided one. In this case we used

a Legacy.

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After milling, try in the Emax and work out the occlusion and contacts before staining and

sintering.

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Use the pin and the object fix while staining and glazing. Do you have to try in again? No, but I

just wanted to make sure I didn't get any glaze in the access.

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The multi-link hybrid abutment cement is awesome. Basically white out that bonds! Less is more,

so after sand blasting, place your mono bond and paint the stuff directly on the Ti-Base. Place a

sponge over the screw or you will be hating life.

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Per a FB friend, I wised up and used Hydrofluoric acid and silane in the screw access. I switched

back to Flow-it ALC opaque flowable as it’s a little more opaque than Kerr Point 4 paste and a

little ochre stain to keep in real.

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Final, this stuff is so much fun!!!

Dr August de Oliveira graduated from dental school in 1997 from the University of Washington

and completed his General Practice Residency in Los Angeles in 1998. Dr de Oliveira has been lecturing

on 3D technology since 2004, when he started as a CEREC Basic trainer. Since 2008 he has been involved

with Implant Direct’s R and D department developing Guided Surgery Software and Hardware and testing

their CAD Milled Bars and Substructure Department. Dr de Oliveira has written two books on

Implantology: Implants Made Easy and Guided Implantology Made Easy. He has been involved with beta

testing Sirona’s Sidexis Program, as well as developing the Opti and CEREC Milled Surgical Guides. Dr de

Oliveira lectures nationwide for Sirona on the Galileos Cone Beam system and Sirona Guided Implant

Surgery. He also teaches for Implant Direct at their Las Vegas Educational Facility and with the Engel

Institute in Charlotte NC. Dr de Oliveira lives and practices in Los Angeles CA.

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MacGyver Guide: Getting Crafty With A Bridge And Final Screw Retained Emax On A Legacy3 Implant

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